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Depression

It's normal to have days or weeks when things aren't going right and you feel unhappy. Depression is when these feelings don't go away quickly and start to interfere with your everyday life, although it can be hard to identify.

Depression is when you have a continuous low mood or lose interest and enjoyment in everyday activities. This lasts longer than a few days or comes back repeatedly. If you’ve had symptoms almost every day for two weeks or more, it’s likely that you’ll be diagnosed with depression.

Around one in 10 adults in the UK will have depression at some point in their lives. People can be affected by it at any age, and women are more likely than men to get the condition.

Details

There are many different types of depression. The condition can be classified as mild, moderate or severe, depending on your symptoms.

Mild depression. This is when you have very few symptoms which don’t have a great impact on your daily life.

Moderate depression. This has a considerable impact on your daily life and you may have more symptoms than people with mild depression.

Severe or major depression. This makes you feel uninterested in doing anything and daily activities are almost impossible, including eating and sleeping. You may feel like you’ve lost touch with reality. For example, you may have hallucinations (hearing, seeing or smelling things that aren't there) or delusions (irrational beliefs). This is known as psychosis.

Other types of depression include the following.

Dysthymia. This is a type of depression in which your mood is regularly low, lasting at least two years. The symptoms are milder than other types of depression.

Bipolar affective disorder. This is also known as manic depression or just bipolar disorder and causes mood swings. Your mood may vary from excitement and elation (mania) to despair and feeling lethargic. In the mania phase, you may also do things that other people find illogical.

Seasonal affective disorder (SAD). This is a type of depression that may affect you during the autumn and winter months. This may be because of the lack of sunlight as daylight hours become shorter.

Postnatal depression. This may develop any time between two weeks and two years after childbirth. One in 10 mothers get postnatal depression and may have problems sleeping, panic attacks or an intense fear of dying.

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There are many symptoms of depression and the condition affects everyone differently. Some that you may have include:

a continuous low mood

a loss of interest in the things you usually enjoy doing

crying a lot

a loss of self-confidence

feeling tired and lacking in energy

poor concentration and difficulty making decisions

feelings of guilt, worthlessness or helplessness

thoughts about death and suicide

a loss of sex drive (libido)

trouble sleeping – possibly taking one or two hours to go to sleep or waking up earlier than usual

disturbed eating patterns, often with weight gain or weight loss

unexplained or worsening aches and pains

smoking or drinking more alcohol than usual

feeling like you can’t cope with things any more

feeling restless or agitated

anxiety – although this is a separate condition, you may have symptoms of depression and anxiety at the same time

Not everybody who has depression will have the same symptoms. Most people with depression will have at least five or six of the symptoms listed above. The severity of your symptoms, their frequency and how long they last will depend on the type of depression you have.

If you're depressed, recognising the problem is the first, but sometimes hardest, step. Often others around you may suggest that you seek help. If you think you have depression, and it’s affecting how you live your life, see your GP or look into what mental health support is available in your area. They can help to support you and may recommend treatment to help stop depression from taking over your life.

There are no tests to diagnose depression. You may be asked about your home life, any previous experience of depression, and whether you have had thoughts about self-harm or suicide. You’ll be asked about your symptoms, their duration and how much they are affecting your everyday life.

Most people with depression are treated by their GP. However, some people with severe depression may be referred to a psychiatrist (a doctor who specialises in mental health).

Treatment for depression usually involves a combination of self-help, talking (psychological) therapies and antidepressant medicines. Your treatment will depend on how severe your condition is.

Self-help

Doing some exercise may help your symptoms. Try different sports or activities to find something you enjoy, and that you can keep doing in the long term. You may not feel like eating if you’re depressed. But this can make you feel worse, so try to eat a healthy, balanced diet with plenty of fruit, vegetables and fibre.

If you drink alcohol whilst taking antidepressants, you may become very sleepy, so the two are best not combined. If you're depressed, it can be tempting to use alcohol to try to make yourself feel better. However, alcohol can affect your sleep and your mood and lead to a range of long-term health problems including liver damage.

If you do drink alcohol, it's important that you don't drink more than the recommended guidelines. See our sensible drinking topic for more information.

Having difficulty sleeping or sleeping too much are both common symptoms of depression. If you’re having problems sleeping, try not to worry about it. You may find that listening to relaxing music in bed will help you feel less anxious about getting to sleep. For more tips on getting a good night’s sleep, see our insomnia topic.

Talking therapies

Counselling is usually a one-to-one session where you have a chance to express your feelings and problems. There are many different types of counselling, but generally you won't be told what to do about your feelings. Instead, a counsellor listens to what you have to say and then helps you to try and see your feelings and problems in a different way.

Psychotherapy aims to help you understand why you feel the way you do. This is usually achieved by talking about your early childhood and significant relationships.

Cognitive behavioural therapy (CBT) may help you change the way you think and the behaviours that are contributing to your depression. Instead of concentrating on the causes of your symptoms from your past, CBT aims to help you feel better by focusing on the here and now. You can have CBT with a therapist in a one-to-one or group session, or by yourself using a self-help book or computer programme.

The type of talking therapy you have will depend on what's available, your preferences, and how severe your depression is. Your GP may be able to arrange for you to have talking therapy as part of your treatment.

Medicines

Antidepressant medicines ease the symptoms of depression in about seven in 10 people with the condition. But if you have mild or moderate depression, you may not need to take them. There are several different types of antidepressant medicines available. All of these can have side-effects (unwanted effects), and some of these are more serious than others. Even if you’re getting unpleasant side-effects, don’t stop taking your medicine without speaking to your GP first.

Antidepressants may take up to two weeks to start having an effect. So it’s important to keep taking your medication even if you don’t immediately feel better. When you first start taking antidepressants, your GP will usually review you every couple of weeks. It can take a while to find the right medicine for you. Be sure to tell your GP if your symptoms don’t improve or get worse, or if you’re at all worried about the medicines you’re taking.

Taking your medication for at least six months after you start to feel better can help prevent your depression coming back. When stopping antidepressants, your GP will usually reduce your dose gradually over at least four weeks. Stopping your medicine suddenly could lead to withdrawal symptoms.

As well your antidepressant treatment, your GP may suggest you take a medicine called lithium or an antipsychotic medicine such as quetiapine.

If you have any questions, ask your GP for advice and always read the patient information leaflet that comes with your medicine. For more information about antidepressants and more detail about different side-effects, see our antidepressants topic.

Complementary therapies

You may decide to try herbal medicines, such as St John's wort (Hypericum perforatum), to help ease mild or moderate depression. You can buy this as tablets in health food stores and pharmacies. However, remember that natural doesn’t mean harmless. Talk to your GP or pharmacist before taking St John's wort, especially if you're taking prescription or over-the-counter medicines (including antidepressants). This is because St John's wort contains active ingredients which may interact with some foods and other commonly used medicines, such as cheese and the contraceptive pill.

Because of these possible interactions, the National Institute for Health and Care Excellence (NICE) doesn’t advise taking St John’s wort for depression. It’s also not clear how much you need to take for it to work well.

Hospital treatment

Most people who have depression can be successfully treated without being admitted to hospital. If you have severe depression with suicidal thoughts or you’re struggling to cope, you, your family, or psychiatrist may feel you need treatment in hospital.

Electroconvulsive therapy (ECT)

You’ll only be offered ECT if you're severely depressed, need urgent treatment or if medicines haven't helped. It involves having an electrical current passed through your brain. ECT is always given in hospital under general anaesthetic, which means you will be asleep during the procedure and feel no pain.

It's not clear how ECT works.

Side-effects of the treatments include headaches, confusion and memory loss. ECT often works very quickly, greatly lifting your depression. However, it doesn't appear to stop depression coming back in the future.

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With our GP services, we aim to give you an appointment the next day or sooner if it’s urgent. Find out more today.

People develop depression for lots of different reasons, although sometimes it’s not possible to pinpoint a cause. It’s likely to result from a combination of your family background, experiences and personality.

Factors that may make you more likely to develop depression can include:

unsettled or difficult relationships with your parents in childhood

divorce, including your parents getting divorced when you were younger

Although most people who have major depression get better with treatment, it’s a chronic (long-term) condition – symptoms can last for up to two years. More than half of all people who have a period of depression will have at least one more during their lifetime. You’re more likely to have several periods of depression if you’re under 20 or in old age when you have your first episode.

Depression can reduce your quality of life and may affect your ability to work, your relationships with friends and family and your general health. For example, it’s linked to doing less physical activity, and drinking too much alcohol. Sometimes, depression can also be associated with suicide.

What can I do to help someone with depression?

Answer

If you know someone who has depression, it's important for you to be reassuring, to listen but not judge, and to be there to talk to. You can also help him or her make an appointment to get help – their GP or local mental health services are good places to start.

Explanation

When people are depressed, they often feel helpless, hopeless and alone. Being affectionate and helping them feel good about themselves by praising daily achievements will help him or her feel better about themselves. Remember, things that may seem small to you may be big steps for them, such as cooking a meal, leaving the house or talking to a friend. People with depression often isolate themselves from others. They may stop seeing friends and relatives. Try to stay in contact, by talking on the phone and visiting if you can.

Encourage the person to seek help and advice. Reassure them that they are important to you, and that they can get better with treatment. If he or she makes any comments about suicide, don’t ignore them. Tell their GP or therapist if you can.

It can be difficult to spend a lot of time with someone who is very depressed – you may start to feel down too. Have some time out as well, and talk to others if you feel frustrated. Support from specialist groups may also be helpful.

Depression in people who have a chronic (long-term) physical illness, such as diabetes or heart disease, is common and often goes undetected. If you're worried about someone, encourage them to talk to their GP about how they are feeling.

Can yoga help depression?

Answer

There is very little proof to suggest that yoga is helpful as a treatment for depression. However, some research studies suggest that certain types of yoga may be beneficial and help reduce common symptoms of depression, such as anxiety and stress.

Explanation

There are different types of yoga and some may be more helpful than others. Ashtanga yoga, for example, can be quite dynamic and fast-paced, while other types, such as Hatha yoga, with mindfulness meditation, are more focused on meditation and breathing. Hatha yoga poses are done slowly and are meant to help with relaxation and awareness. These may help to de-stress your mind – something that can be helpful if you’re depressed.

Doing some exercise in addition to taking medicine or having counselling may help your symptoms.

Does acupuncture work for depression?

Answer

At the moment, there isn't enough medical proof suggesting that acupuncture is helpful in treating depression.

Explanation

Acupuncture has been part of traditional Chinese medicine for thousands of years but only in the past 30 years has it become integrated into general medicine. It's used mostly as a complementary treatment (one given alongside conventional treatments).

Evidence suggests that acupuncture needles stimulate nerve endings and may alter the way your brain works to correct the imbalance of energy in your body. However, there isn't enough proof to support the use of acupuncture as a treatment for depression.

Taking time out to do things that make you feel good may help lift your mood. Eating a healthy diet, getting enough sleep, and making the time to rest, relax and exercise are all important ways to look after yourself.

Further information

This tool describes itself as gym membership for your mind using meditation and mindfulness techniques. You can start off with free 10-day introduction to meditation and then choose to subscribe for access to more exercises covering a range of topics. You can use it on your phone or computer, depending on what suits you best.

This online, anonymous community provides a secure environment for you to seek help if you’re feeling stressed, anxious or down about anything. You can share stories to get and give advice, find information and do courses to understand better how you’re feeling and make positive change. And trained professionals keep an eye on things 24 hours a day to make sure everyone stays safe and supported.

This website-based mindfulness programme is made up of 10 30-minute modules for you to do at your own pace. It teaches mindfulness techniques to help you manage stress or simply to try to live a happier, healthier life. The programme uses audio clips, text-based information and a library of resources and exercises, and you can track your progress as you go along.

The Mental Health Foundation is a charity that carries out research and offers information about many areas of mental health. Their content on depression covers the different types and practical advice on ways that you can take control to try to help yourself feel better.

The charity Mind has information to support people with a mental health condition and those who care for them. If you’d like to hear about how it feels to have depression and ways of coping, have a look at their video of people talking about their experiences.

This charity has support groups, runs campaigns and can direct you to local mental health services, as well as providing information. This factsheet that you can download has comprehensive information about the different types of depression and directs to other, more specific guidance.

This charity aims to raise awareness of issues associated with living with depression and end the stigma that can go with it. The content on these pages deals with what depression is, treatment options and how to live as well as you can.

Support from people who are going through the same experiences as you can be invaluable. These links take you to information about different options depending on what suits you.
Wellbeing Networks are social groups where you can meet others face to face and do a range of activities.

CALM (Campaign Against Living Miserably) is a charity that exists primarily to prevent male suicide. Through their confidential helpline and website, they offer support for all men when things go wrong. Their straight-talking information talks about the ways that depression can affect men and where to go for help.

Sources

Depressive disorders. The Merck Manuals. www.merckmanuals.com, published December 2013

Depression. Royal College of Psychiatrists. www.rcpsych.ac.uk, published October 2013

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